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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Maja CholodyPartners for DevelopmentSilver Spring, Maryland, United States

Grand Challenges for Development

Saving Lives at Birth

1 Jan 2011

Partners for Development (PFD) will develop an innovative model to ensure access to ante/postnatal and delivery care (ANC/PNC) in 25 underserved villages in northeastern Cambodia: a transportation system of private sector providers in partnership with local government. To increase demand for such transport and make the system financially sustainable, routes will include schools, markets and other popular destinations in addition to health facilities. Costs will be affordable to consumers and prices adequate for providers via set monthly amounts paid to the providers. In exchange for the monthly payment by the village, the private providers will agree to create affordable transport rates for users. Each village's cost contribution will be calculated according to the distance from its borders to the next stop on the route, reducing the otherwise high cost to the furthermost areas. Families will pay a monthly rate to its respective Village Development Council for unlimited trips, removing what is otherwise a financial disincentive to preventive care. The VDC will then pay each transporter, guaranteeing 24-hour availability. Revolving village loan funds can provide for emergency travel. Villages will: determine optimal routing; establish household fees; set loan interest rates/repayment terms; and determine how to publicize the system. PFD will measure success by: changes in ANC/PNC delivery service utilization; household subscription rates; and transporter profits. The model has replication potential globally.

Jhpiego and its partners (Johns Hopkins University Center for Bioengineering Innovation and Design and Laerdal Global Health) propose to rapidly develop and conduct initial field-testing for an "E-Partogram", an affordable, easy-to-use, handheld electronic decision-making tool for preventing or managing complications during labor. The E-partogram could positively transform safe childbirth by enabling front-line providers to more rapidly assess and respond to labor complications and receive crucial guidance to save the lives of women and newborns.

Baby Monitor, a mobile interactive voice response system, will bring clinical assessment and referrals directly to mothers and their infants in resource-poor settings who are unlikely to access routine care. To date, mobile applications largely have been used to send patient reminders and health information or to collect patient information through intermediaries such as community health workers. Patients in developing countries have not been end-users of mobile diagnostic tools and medical record systems. If successful, this innovation could save lives, improve health outcomes, and optimize the use of extension workers in rural and remote regions where access to health systems is limited and clinical assessment often occurs too late or not at all. Baby Monitor will help mothers to assess the signs and symptoms of newborn and maternal ill-health in the weeks before and after birth. The system will assess responses to verbal screening questions, provide mothers with health information, and, when necessary, make referrals, alert healthcare providers, and dispatch appropriate healthcare workers.

In Nepal, despite recent efforts to increase deliveries attended by a skilled provider, fewer than 20 percent are reached with such care. Much of the population faces significant geographic barriers to care, and a large proportion of newborns are exposed to poor hygiene conditions over their first few days of life. Nearly 70 percent of infant deaths occur within the first month of life, the most common cause being infection. A trial in Nepal has shown that risk of death can be reduced by 24 percent with application of the antiseptic chlorhexidine (CHX) to the umbilical cord stump. In four pilot districts, JSI has tested and successfully shown a multi-channel distribution approach, relying primarily on a nationwide cadre of female community health volunteers (FCHV) who already provide other antenatal care (ANC) support. JSI proposes scaling up these approaches as a realistic strategy to rapidly and sustainably achieve high coverage of CHX application to the newborn cord stump, nationwide.

The specific aim of the proposed study is to test the safety and feasibility of a new low-cost device (Odon Device: http://www.youtube.com/watch?v=OGLLXFzULd4) to deliver the fetus during the second stage of labor. This device may be potentially safer and easier to apply than forceps/vacuum extractor for assisted deliveries, and a safe alternative to some Caesarean sections in settings with limited surgical capacity and human resource constraints. It has potential for wide application in resource poor settings even by mid-level providers. If proven safe and effective, the Odon Device will be the first innovation in operative vaginal delivery since the development of forceps centuries ago and vacuum extractor decades ago.

Preterm birth leads to more annual neonatal deaths (1 million) than any other single cause; these deaths primarily occur in low income settings where many infants are born at home and gestational age is rarely assessed. Innovative ways to identify preterm infants in the community are needed to facilitate rapid and appropriate targeting of interventions and referral. Newborn clinical assessment by medically trained personnel allows accurate estimation of gestational age, but methods are complex and simplified methods have not been developed and validated for use by community health workers (CHWs). We have developed a simple, color-coded pictorial scorecard intended for use by CHWs to identify early preterm (<34 weeks=red zone) and late preterm (34-37 weeks= yellow zone) infants. Validation of this simple tool for use by CHWs may help reduce the large burden of newborn deaths related to prematurity.

An HIV+ mother will often be reluctant to travel to a clinic the day or two after delivering her baby. She may feel too weak to travel to a clinic miles away or fear stigmatization after explaining why she must go to a clinic after delivering a healthy baby. This leaves millions of children at risk of becoming HIV+ during the birthing process. We have developed and tested in the laboratory a foilized, polyethylene pouch - something like a fast-food ketchup pouch - that can store the medication for months. If the mother is unable to make it to the hospital to deliver, she can tear open the pouch and provide the drugs to the infant, preventing her newborn from becoming HIV+.

Through a partnership between bioengineers at Rice University, pediatricians at the University of Malawi and Baylor College of Medicine, and industrial design engineers from 3rd Stone Design have designed a novel, rugged bubble Continuous Positive Airway Pressure (bCPAP) system which can be made in small volume at low-cost. This proposal will: (1) rigorously test the efficacy of this device at Queen Elizabeth Central Hospital in Blantyre, Malawi and refine it for use in rural district hospitals; (2) design a complementary training program for nurses and electromedical hospital staff; (3) engineer the bCPAP system for commercial manufacture; and (4) develop a country-wide plan to implement bCPAP at all district hospitals in Malawi. We estimate that on the African continent, where nearly one million babies die each year within a week of birth, the availability of affordable, effective bCPAP could reduce early neonatal mortality rates by as much as 30%.

Grameen Foundation, in partnership with Ghana Health Service, aims to expand the successfully piloted MOTECH (Mobile Technology for Community Health) initiative to two new districts in a transition plan towards national scale-up. The program will reach approximately 14,000 pregnant women and 46,000 children under five over the two-year implementation, increasing access to accurate health information, generating increased demand for antenatal, postnatal and neonatal care, and providing detailed data on health service delivery and outcomes to Ghana Health Service. MOTECH has two interrelated mobile applications which focus on improving the health of pregnant women and infants in poor rural areas: Mobile Midwife sends targeted, time-specific, evidence-based voice messages containing important health information to pregnant women and new parents in their local language and the Nurse Application allows community health nurses to electronically record care given to patients so they can easily identify clients in their area due for critical care. If a patient misses scheduled antenatal care, the Mobile Midwife service sends a message to remind the woman to go to the clinic. If she fails to attend, her nurse is alerted via text message enabling the nurse to follow up quickly.

Hanifah SegendoSave the Children Federation, IncWestport, Connecticut, United States

Grand Challenges for Development

Saving Lives at Birth

1 Jan 2011

This proposal involves testing an innovative fetal heart rate monitor powered by human energy (winner of the global INDEX design award) and mobile phone based mortality audit data to improve timely and appropriate action. Uganda's new national paper-based mortality audit system will be adapted to a mobile phone platform to capture maternal and neonatal deaths and stillbirths, and use this data to improve intrapartum monitoring and response. Facilities will collect this data and will be linked to communities using cell phones to request emergency transport and report births and deaths.

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